Provider Demographics
NPI:1336323617
Name:KUBICA, LUCILLE M (RN)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:M
Last Name:KUBICA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LUCILLE
Other - Middle Name:M
Other - Last Name:MORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3939 N NEW ENGLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2349
Mailing Address - Country:US
Mailing Address - Phone:773-427-2866
Mailing Address - Fax:
Practice Address - Street 1:3939 N NEW ENGLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2349
Practice Address - Country:US
Practice Address - Phone:773-427-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-22
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse